Share Your Story

You may have lost someone you loved or know someone who has died of a preventable cause in a hospital. If that is the case, we would like to express our deepest sympathy. We can’t explain why a place of healing became a cause of tragedy. What we can do is much more modest: extend an invitation to you to join patient advocates, mothers and fathers, wives and husbands, and sons and daughters who are working passionately towards a single goal – ZERO preventable deaths by 2020. If you’re ready to Join the Movement, we will welcome you – with gratitude and appreciation. Your story will become an integral part of the narrative driving the Patient Safety Movement forward. Please consider sharing your story with the Patient Safety Movement. Complete the form below and we will contact you to learn more.

Your Information

If you are affiliated with an organization that relates to this story, please share that with us.

Organization's Website

If applicable, please indicate whether this event launched an organization or group that you'd like to share with us.

Details about the Story

NO LONGER VISIBLE PUBLICLY: Whose story are you interested in sharing?

Name of the person featured in this story

FirstLast

Is this person still alive?*

Yes

No

When did this event take place?*

MM

DD

YYYY

This may be the date that the event occurred in the hospital or the date a loved one passed away.

Where did this event take place?*

CityState / Province / RegionCountry

Tell us the story*

You have 3,500 characters (or about two pages of text) to tell your story. If you need more space please email story@patientsafetymovement.org

Does this story align with any of the Foundation's Patient Safety Challenges?

If you are unsure you may leave this blank. If you'd like to select more than one choice below, please hold down the COMMAND key (mac) or CTRL key (pc).

Upload an Image*

Accepted file types: jpg, png.

Please upload an image of the person who is represented in the story. Provide us with the highest resolution image as possible, and please upload a color photo.

Acknowledgement*

I hereby authorize The Patient Safety Movement Foundation (PSMF) and assign the rights to display, publicly perform, exhibit, transmit, broadcast, reproduce, record, photograph, digitize, modify, alter, edit, adapt, create derivative works, otherwise use, and permit others to use, the name, logo(s), publicly available data and images of the person listed above and its relevant affiliates on any platform and for any purpose including, but not limited to, advertising, public relations, publicity, packaging, and promotion of the PSMF without further consent or consideration from the person listed above.

Community

Our Community brings patients, patient advocates, clinicians, government officials, healthcare leaders and medical technologists together to connect, share and discuss ideas that will help eliminate preventable patient deaths. Please join us so you can inspire, motivate, share, discuss, engage and connect with others to synergize The Patient Safety Movement and help us achieve our goal of ZERO preventable patient deaths by 2020 together.

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Community

Our Community brings patients, patient advocates, clinicians, government officials, healthcare leaders and medical technologists together to connect, share and discuss ideas that will help eliminate preventable patient deaths. Please join us so you can inspire, motivate, share, discuss, engage and connect with others to synergize The Patient Safety Movement and help us achieve our goal of ZERO preventable patient deaths by 2020 together.